Comparison of Outcomes in Level i vs Level II Trauma Centers in Patients Undergoing Craniotomy or Craniectomy for Severe Traumatic Brain Injury

Nohra Chalouhi, Nikolaos Mouchtouris, Fadi Al Saiegh, Robert M. Starke, Thana Theofanis, Somnath O. Das, Jack Jallo

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

BACKGROUND: Traumatic brain injury (TBI) carries a devastatingly high rate of morbidity and mortality. OBJECTIVE: To assess whether patients undergoing craniotomy/craniectomy for severe TBI fare better at level I than level II trauma centers in a mature trauma system. METHODS: The data were extracted from the Pennsylvania Trauma Outcome Study database. Inclusion criteria were patients > 18 yr with severe TBI (Glasgow Coma Scale [GCS] score less than 9) undergoing craniotomy or craniectomy in the state of Pennsylvania from January 1, 2002 through September 30, 2017. RESULTS: Of 3980 patients, 2568 (64.5%) were treated at level I trauma centers and 1412 (35.5%) at level II centers. Baseline characteristics were similar between the 2 groups except for significantly worse GCS scores at admission in level I centers (P =. 002). The rate of in-hospital mortality was 37.6% in level I centers vs 40.4% in level II centers (P =. 08). Mean Functional Independence Measure (FIM) scores at discharge were significantly higher in level I (10.9 ± 5.5) than level II centers (9.8 ± 5.3; P <. 005). In multivariate analysis, treatment at level II trauma centers was significantly associated with in-hospital mortality (odds ratio, 1.2; 95% confidence interval, 1.03-1.37; P =. 01) and worse FIM scores (odds ratio, 1.4; 95% confidence interval, 1.1-1.7; P =. 001). Mean hospital and ICU length of stay were significantly longer in level I centers (P <. 005). CONCLUSION: This study showed superior functional outcomes and lower mortality rates in patients undergoing a neurosurgical procedure for severe TBI in level I trauma centers.

Original languageEnglish (US)
Pages (from-to)107-111
Number of pages5
JournalNeurosurgery
Volume86
Issue number1
DOIs
StatePublished - Jan 1 2020

Keywords

  • Craniectomy
  • Craniotomy
  • Trauma centers
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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